Blood volume and red cell mass in children with moderate and severe malaria measured by chromium-53 dilution and gas chromatography/mass spectrometric analysis

Authors

  • Derek C. Macallan,

    Corresponding author
    1. Division of Cellular and Molecular Medicine, Centre for Infection, St. George's Hospital Medical School, London SW17 0RE, UK
    • Centre for Infection, St George's, University of London, Cranmer Terrace, London SW17 0RE. UK.
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  • Daniel A. Abaye,

    1. Division of Cellular and Molecular Medicine, Centre for Infection, St. George's Hospital Medical School, London SW17 0RE, UK
    Current affiliation:
    1. Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre, Rankine Avenue, East Kilbide G75 0QF, UK.
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  • Simone Dottin,

    1. Division of Cellular and Molecular Medicine, Centre for Infection, St. George's Hospital Medical School, London SW17 0RE, UK
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  • Myriam Onanga,

    1. Département de Parasitologie, Mycologie et Médecine Tropicale, Faculté de Médecine et des Sciences de la Santé, Libreville, Gabon
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  • Maryvonne Kombila,

    1. Département de Parasitologie, Mycologie et Médecine Tropicale, Faculté de Médecine et des Sciences de la Santé, Libreville, Gabon
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  • Arnaud Dzeing-Ella,

    1. Département de Parasitologie, Mycologie et Médecine Tropicale, Faculté de Médecine et des Sciences de la Santé, Libreville, Gabon
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  • Peter G. Kremsner,

    1. Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
    2. Sektion Humanparasitologie, Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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  • Sanjeev Krishna,

    1. Division of Cellular and Molecular Medicine, Centre for Infection, St. George's Hospital Medical School, London SW17 0RE, UK
    2. Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
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  • Timothy Planche

    1. Division of Cellular and Molecular Medicine, Centre for Infection, St. George's Hospital Medical School, London SW17 0RE, UK
    2. Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
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  • Presented at the 2nd Joint European Stable Isotope User Meeting (JESIUM), Presqu'île de Giens, France, 31 August–5 September, 2008.

Abstract

Understanding blood volume changes in children with malaria is important for managing fluid status. Traditionally, blood/red cell volume measurements have used radioactive chromium isotopes. We applied an alternative approach, using non-radioactive chromium-53 labelling and mass spectrometry to investigate red cell volume (RCV) in Gabonese children with malaria. Nineteen children with malaria participated (10 severe, 9 moderately severe; ages 15 months to 7 years). Blood labelled with 53Cr-chromate exvivo was re-injected, then sampled 30 min later. Pre- and post-injection 53Cr content were measured by gas chromatography/electron ionisation mass spectrometry of the chromium-trifluoroacetylacetone (TFA) chelate, calibrated against 50Cr standards. Blood and red cell volumes were calculated from isotopic dilution in 15 of 19 children (in four, insufficient signal mitigated analysis). In this small pilot study, there were no significant differences between moderate and severe cases. Including all subjects, the mean RCV was reduced compared with predicted values (184 vs. 269 mL; p = 0.016) but blood volume, 71 ± 33 mL/kg (normalised for weight), was close to predicted, ∼77 mL/kg, commensurate with reduced haematocrit. Blood lactate concentration correlated negatively with RCV/weight (r = −0.56, p = 0.028), consistent with anaemia. In one case, sequential samples over 42 days gave an estimated rate of 53Cr disappearance of 1.4%/day (equivalent half-life: 70 days). 53Cr-labelling of red cells may be used to estimate blood and red cell volumes and can be used as an investigative tool in situations such as childhood diseases and resource-constrained settings. Although the red cell mass is depleted in malaria, the blood volume appears relatively well preserved. Copyright © 2009 John Wiley & Sons, Ltd.

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